Forms & Documents

• Forms/Documents
• Business Group of One
• Small Group
• Large Groups

FORMS / DOCUMENTS

RMHP offers you on-line access to your health plan Employer Group Manual. By downloading the Employer Group Manual or the Business Group of One Manual, you can reference administrative procedures relating to enrollment and disenrollment requirements, continuation of coverage requirements, and premium billing explanations.

You can download service-related forms needed for current employer groups by clicking on the links below.

Certification of Dependent Status

Authorization for Release of Information

Disenrollment Form

Change Form (to add or drop a dependent)

Change Form - Spanish (to add or drop a dependent)

Notice of Qualifying Event Form COBRA/CCOC

Electronic Funds Transfer for Employer Groups

Request for Enrollment of Common Law Spouse

Request for Enrollment of a Disabled Dependent

BUSINESS GROUP OF ONE

If you qualify as a Business Group of One, you have on-line access to the application and enrollment forms required to apply for coverage with RMHP. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office near you.

Application Forms for Business Groups of One

Click on the links below to download application forms.

Uniform Employee Application

Uniform Employee Application - Spanish Version

Attestation - Business Group of One

Open Enrollment Certification - Business Group of One

New Group Checklist

SMALL GROUP

If you qualify as a Small Employer Group (2 to 50 employees), you have on-line access to the application and enrollment forms required to apply for coverage with RMHP. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office near you.

Application Forms for Small Groups

Click on the links below to download application forms.

Uniform Employee Application (used to enroll or waive coverage)

Uniform Employee Application - Spanish Version

LARGE GROUPS

If you qualify as a Large Employer Group (51+ employees), you have on-line access to the application and enrollment forms required to apply for coverage with RMHP. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office near you.

Application Forms for Large Groups

Click on the links below to download application forms.

Certification of Dependent Status

Enrollment Form - Group Coverage

Enrollment Form - Group Coverage - Spanish 

Employee-Dependent Waiver